What you Don't Know CAN Hurt You
Updated: Feb 10
Why you must get the Right Thyroid Tests
Thyroid is one of the most vital hormones in your body and unfortunately one of the most under diagnosed and improperly treated health conditions. It influences every cell, organ and hormone in your body which is why there are over 200 symptoms related to low thyroid. It’s not enough to have ‘some’ thyroid hormone. Every cell needs exactly the right amount
You may find that you describe thyroid symptoms to your physician, but end up with another diagnosis. If you say the words "fatigue," "weight gain," and "depression" to many doctors, you may leave the office not with thyroid tests but with a prescription for an antidepressant or anti-anxiety. Or you may be told that it's your hormones (which is essentially true, but they're talking about the wrong hormones!) Or you may be told you're experiencing the effects of getting older, working too hard, too much stress, postpartum symptoms, or lack of exercise.
The symptoms of low thyroid should be taken seriously as undiagnosed low thyroid has important health concerns.
Symptoms of low thyroid: fatigue, elevated cholesterol and triglycerides, sluggish thoughts and memory, depression, constipation, weight gain, dry skin, cold intolerance, joint and muscle pain, headaches, PMS symptoms, changes in hair and nails and many more.
The Importance of Subclinical Hypothyroidism
In 2000 the Colorado Thyroid Disease Prevalence Study, set out to determine how common abnormal thyroid function actually is, and to look at the relationship between abnormal thyroid function, cholesterol levels, and thyroid symptoms. The study was funded by the Knoll pharmaceutical Co which manufactures Synthroid and published in the Archives of Internal Medicine. The conclusions were as follow:
9.9% of the population had an undiagnosed thyroid abnormality which suggests that 13 million Americans have an undiagnosed thyroid condition.
Those with subclinical hypothyroidism had increased cholesterol levels. This confirmed the Rotterdam study done in 1997 which found that older women with subclinical hypothyroidism were twice as likely to have blockages of the aorta and to have had heart attacks. Many other studies have also shown the link between low thyroid and heart disease.
The Colorado Study also found that patients reported more symptoms such as hoarse voice, constipation, feeling tired, puffy eyes, muscle cramps, slower thinking, among others.
According to one of the study's authors, E. Chester Ridgeway, MD, head of the Division of Endocrinology at the University of Colorado Health Sciences Center:
"The link between all stages of hypothyroidism and cardiovascular health, and the vague correlation between symptoms and disease state, points to the need for more widespread thyroid stimulating hormone (TSH) testing and more aggressive treatment, especially for subclinical patients."
The researchers also found that nearly 40% of those who were taking thyroid medication still had abnormal TSH levels, indicating a need for closer monitoring.
For the purposes of the study, normal TSH range was a TSH level between 0.3 and 5.1 mIU/L, subclinical hypothyroidism was characterized by an elevated TSH level (greater than 5.1 mIU/L) and a normal T4, and overt hypothyroidism was evaluated as an elevated TSH level (greater than 10.0 mIU/L) and a decreased T4.
I’m citing this study, along with the Rotterdam study, to highlight the health consequences of undiagnosed and unknown low thyroid.
But the number of people with subclinical hypothyroidism is actually much larger. In fact the American Thyroid Association says that up to 60% of the people with thyroid dysfunction don’t even realize that they have a problem. But given the health consequences of low thyroid, proper testing (not just a TSH) should be part of routine preventive health care.
Thyroid disorders are best detected early before they can trigger other medical problems. But The American Academy of Family Physicians recommends against routine thyroid screening in asymptomatic patients younger than 60.
The Right Tests for Low Thyroid
Click here for more information about how to read thyroid tests.
Most physicians diagnose hypothyroidism only on the thyroid stimulating hormone (TSH) test. These doctors believe that if the TSH test result shows you as being within the TSH "reference range" for normal that they subscribe to, then you do not have a thyroid dysfunction. This assessment is based on a controversial practice even among endocrinologists.
There is disagreement as to the "reference range" for the TSH test itself, and for a decade, doctors have disagreed over the guidelines, but they have not been formally changed. So, while the so-called "normal" reference range at many labs continues to be shown as from around .5 to 5.0, some endocrinologists use the range of .3 to 3.0 in their practice, and a subset of practitioners believe that the top end of the range actually should be lowered even further to 2.5. Most Integrative Physicians will use a more narrower range between 1 and 1.5uIU/mL as optimal.
Any way you look at it, according to the narrower recommended range, millions more people than cited in the Colorado study are considered hypothyroid, and could qualify for treatment.
And if your TSH is borderline -- or what some physicians refer to as subclinical -- your doctor may refuse to treat you, or suggest that you wait until the TSH goes up further before you get treatment. But an under-active thyroid that goes untreated will worsen over time causing a deterioration of your health.
Over-reliance on the TSH Test, and Failure to Test Free T4/Free T3
Another challenge for patients who have a TSH that is normal -- even if by the new standards -- is that a normal TSH may not reflect what is actually going on in terms of the actual circulating levels of thyroid hormone in the body.
The best measurements of your thyroid are the Free T4 and more important the biologically active Free T3 tests. T4 is the storage form of the hormone and does not enter the cell. TSH measures T4 and not T3.
Some practitioners feel it is especially important that the Free T3, in particular to be in the upper end of the normal range, for patients to feel well. What this means is that if you have a "normal," TSH, but your Free T4 and/or Free T3 are in the lower half of the normal range, you will still have symptoms of low thyroid and all the health ramifications of hypothyroidism.
It’s important to remember that normal does not equal optimal.
Most patient’s symptoms will not improve until their Free T3 levels are raised to the upper range of normal which is the optimal range.
The Challenge of Diagnosing Thyroid Disease
We often hear doctors saying, "Thyroid disease is easy to diagnose and easy to treat,” as they are only testing TSH and using standard reference ranges. But the reality is that thyroid diagnosis can be complicated. Many doctors don't recognize thyroid symptoms at first glance, so patients who are struggling with weight gain, or fatigue, are told to eat less and exercise, or get more sleep, instead of getting thyroid tests. Once thyroid problems are suspected, some doctors will perform only one test - the Thyroid Stimulating Hormone (TSH) test - and then base their diagnosis only on that result and only treating when the TSH is clinically relevant which is 10 or higher.
There are over 500 million patient visits to a physician due to fatigue. Rarely are they finding relief as most of these probably have subclinical hypothyroidism and are not being treated. Fatigue is not a normal part of one’s hectic life, nor is it a typical aspect of aging.
Using Basal Body Temperature to Diagnose Hypothyroidism
Optimal thyroid regulates the body’s temperature. Our bodies work efficiently at the temperature of 98.6. This temperature is essential for proper enzyme function, cerebral function and preservation of health.
The late Broda Barnes, M.D. made the public more widely aware of the use of axillary (underarm) basal body temperature (BBT) as a symptom and diagnostic tool for hypothyroidism. It is a diagnostic and monitoring method still used by some complementary and alternative practitioners.
To measure your BBT, use a mercury thermometer. As soon as you awake, with minimal movement, put the thermometer in your armpit, next to the skin, and leave it for ten minutes. Record the readings for three to five consecutive days. Women who still have their menstrual period should not test on the first five days of their period but can begin on day five. Men, and girls and women who are not menstruating can test any time of the month.
If the average BBT is below 97.6 Fahrenheit, some complementary practitioners would consider a diagnosis of an underfunctioning thyroid or insufficient thyroid hormone replacement. An average BBT between 97.8 and 98.2 is considered normal. Temperatures from 97.6 to 98.0 degrees Fahrenheit are considered evidence of possible hypothyroidism, and temperatures less than 97.6 degrees can be even more indicative of hypothyroidism. Some practitioners, however, consider any temperature under 98 degrees to be indicative of hypothyroidism.
Use of basal body temperature is controversial, however, and even those practitioners who use the test caution that it should be part of an overall approach, and not solely relied upon.
Thyroid testing is complex and challenging but a thorough thyroid evaluation is necessary. Diagnostic tests should be looked upon as a guide that allows the physician to more thoroughly understand and treat the patient. The physician should listen to the symptoms presented by the patient and treat the patient rather than the test.
Donald Bergman, MD, president of the American Assn. of Clinical Endocrinologists, includes a swipe at the nation's health care system. "Why aren't people doing a simple blood test to figure out if patients have mild thyroid disease before they get symptomatic?" he said.
The thyroid is vital to one’s health and even a small decline in the output of thyroid hormone, if sustained over an extended period of time, can have profound consequences on health and longevity.
Talk to your doctor now about having your thyroid check. It's true preventive care.
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